When faced with eye strain, should you use eye drops, new spectacles, do eye exercises and work harder or should you take rest?
Consider it this way: if you ran a marathon everyday even if your legs were paining and cramping, would you do more leg exercises, use crutches and apply oil on your legs to continue the marathon, or would you take rest? The marathon is an analogy to the way we use our eyes without taking rest. The crutches and oil are an analogy to how we use spectacles, eye drops, eye exercises, blue light filters etc., hoping that it would cure us.
(blue light filters were researched and there was no evidence of it being effective: Paper1, Paper2, more citations).
Sure, if the strain is mild, some remedies do appear to give a little relief, but they are only treating the symptoms. We should not pretend that it is working. We need to treat the root cause and cure it. I realized after a decade of chronic eye strain, that there's an obvious, common-sense first-step to the healing process.
Discovering the truth
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| Doctors tend to focus on intraocular muscles. A less considered fact is how extraocular muscles (shown in red) are affected. I’ve felt excruciating pain in those areas for many years. |
In my case, it began with a burning feeling at the front of my eyeballs. Then came the light sensitivity, occasional sharp pains at the sides of the eyeballs, which became sharp stabbing pains all around and behind my eyeballs. I ignored that too and continued working. Then came severe pain all over the eyes, eye muscles twitching, tightness at the cheek muscles that even spread to the forehead muscles. The sharp stabbing pains continued, and my eyes were paining every waking minute of the day. I found it difficult to even keep my eyes open for too long. This is what chronic eye strain feels like. During the next few years, I consulted plenty of doctors (even at highly recommended eye specialty hospitals). They examined my eyes and found no defect other than myopia. No doctor had even heard of such a severe case of eye strain. They tried their genuine best to help, and I could see they felt bad, because they wanted to help me recover (bless them), but they didn’t know how to cure me. Medical science doesn’t seem to have given enough attention to the root causes of fatigue-related eye strain. Practitioners of ancient traditional medicine couldn’t help either.
My eyes just continued aching and burning every single day, throughout the day for six more years, and I continued using the computer for many hours as usual, despite the pain…because I thought I had no other option. Added to that was the mockery from many who thought I was exaggerating.
The persistent pain finally drove me to note down daily experiences. Over a period of few years, multiple experiments, correlations and keen observation, coupled with consultation with a doctor, I finally found the cure and started recovering.
The Cure
It’s necessary to follow these points very strictly. Depending on the level of strain, it can take anything from a few months to few years to get cured, but this is the only way to cure fatigue-related eye strain. Nothing else works.
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| Table created by Hirshkowitz M, et al.(March 2015) |
- Eight hours of uninterrupted sleep every night: This is the foundation. Without this, nothing else will cure the strain. We assume we are getting enough sleep because we feel refreshed when we wake up…and then don’t notice that we still feel sleepy during the day. Before my eye strain became chronic, I hadn’t noticed I was getting only 4 or 6 hours of sleep for many months (a polysomnography didn't help, since doctors were blissfully unaware of what to evaluate for fatigue-related eye strain). During my own experiments, I noted that it was only after 8 hours of uninterrupted sleep, that my eyes felt fine. Interruptions in sleep or short duration of sleep does not seem to allow the muscles and tissues to heal (see Allostatic load). Strain appears to accumulate everyday due to lack of proper sleep. You’ll also notice that you are able to see much clearer than usual, after you get 8 hours of restful sleep. Children need more than 8 hours of sleep, and noise etc. disrupts sleep.
- Closing the eyes after 20 minutes of strenuous work: Twenty minutes (or lesser) of work followed by closing the eyes, relaxing the face muscles and neck muscles and waiting until the strain subsides (the way we maintain tension in our muscles is a part of the problem). It helps to install software that reminds you to rest at intervals. Even if you don’t feel strained, stop after 20 minutes and rest. It’s necessary. Some people say 40 minutes. That's wrong. It's 20, and it applies even to people without eye strain. The “20” is not some random number. It’s from many years of experimentation. Still, rather than blindly follow a number, pay attention to how much time it takes for your eyes to get strained, and try resting your eyes before the pain starts. There is no work that is more important than your eyes. I’ve tried eye drops, an eye gel, anti-reflective coatings, blue-light reduction, eye exercises, washing the eyes, the 20–20–20 rule, expensive eye glasses and all the other advice that doctors and common folk think is a cure for eye strain. Nothing worked. At my level of severity, even minor differences were noticeable. The ONLY way to rest the eyes and get relief from fatigue-related strain, is to keep the eyes closed until the strain subsides. It's not necessary to rest every 20 minutes for tasks like watching a movie, as it's less strenuous. Pay attention to the tiredness/pain signals that your eyes give you. I created a software named iRest which allows resting the eyes in the right way.
- Stop using wrong spectacle lenses: Over many years, I noticed that for strained eyes, computerised eye tests or even a manual eye test were not necessarily sufficient to determine the correct power. When spectacles caused strain, it was important to stop using them, and find out what the eyes felt comfortable with. More details are mentioned in the "Precautions and Observations" below.
- A well balanced diet of properly cooked food: It’s extremely important to know that when food is not properly cooked or even slightly burnt, it causes discomfort in the digestive system (most of the time you won’t even notice this discomfort) that leads to sleep loss (I’ve mentioned more about this in the stomach test blog post). I have noticed muscles feeling less moveable after certain foods or contaminants in foods affect the body. I'm still trying to figure out the what and why of it. Take some extra time to chew your food well. Also, ensure you search the internet and understand what a “well balanced diet” means, and why it’s important. Instead of searching only for foods that can help the eyes, make sure your entire body gets the nutrition it needs. Bodily functions are highly interconnected. When muscles go through strenuous activity, they need a proportional amount of protein (There’s a wide variety of proteins. Chicken meat worked best for me. I have no clue about what protein sources would work for vegetarians). The body also needs natural foods that help with long duration sleep and deep sleep.
- Disbelief in magic: If you wish for a quick magical cure, you could get misled by people selling such “cures”. Magical eye drops, magical monitors, magical spectacle lens coatings, magical spectacle lenses, magical supplement tablets, etc. It’s like having a fractured leg, using a bandage that promises to cure leg pain, and running a marathon everyday, while complaining that the leg pain isn’t reducing. If your eyes are burning/paining frequently, you’ve likely entered an acute (recovery takes weeks or months) or chronic (recovery takes months or years) stage of strain. You may recover faster, but since my strain was extremely severe, it took 3 years for the constant soreness of my eye muscles to stop, and it stopped only because I strictly followed the 3 points mentioned above. Prior to the 3 years, I suffered the pain for 6 years because I didn’t stop the long hours of computer use and didn’t ensure that I got proper sleep. To recover, you need patience and discipline. Not magic. The earlier you start, the faster you'll recover. When the body needs rest, give it rest. Any other work can wait. Else, you’ll end up with a severe burnout that will prevent you from working anyway. It’s not worth permanently damaging health for any company. You can always find another job, but if you ruin your health you could end up permanently crippled. Definitely not worth damaging your eyes for playing games.
Eye strain and myopia can be caused by many other factors too. Those are best diagnosed and treated by a qualified ophthalmologist. Everything I’ve mentioned here, is only for eye strain that’s caused by excess fatigue to the eyes and lack of sleep.
Precautions and Observations
- No eye exercises: Tired muscles need rest. Not exercise. When your eyes are strained, do not do eye exercises. Just close your eyes to rest them.
- Full body exercises: It was of no use in curing or reducing eye strain, and it resulted in better sleep only during the first week. However, full body exercises are very necessary for general health.
- The “SCREAMING”: The pain/burning/discomfort is basically your eyes screaming at you, begging for rest. Never ignore or delay it.
- Prevention better than cure: Instead of allowing eye muscles to cross the threshold of endurance and enter a state of pain, and then using eye drops or warm compresses to soothe the pain, it’s far better to rest your eyes before the pain starts. I have not needed eye drops ever since I ensured I took periodic rest and got proper sleep.
- 20–20–20 rule is wrong: The right way to do it is to close the eyes, relax all muscles, and wait for as long as it takes for the strain to reduce. Later I found out that the creator of the rule himself said it is flawed.
- Digital screen settings: It helped a little bit when I reduced my computer and smartphone brightness to the lowest level I was comfortable with, and used the monitor’s preset “warm” setting. Alternatively, the free night-filter/red-shift apps are also good, but these won’t cure strain. What also helped, was positioning the screens in such a way that reflections on the screen did not cause glare. Anti-glare coatings did not reduce my strain even a little bit because digital screens or blue light was not the reason for strain. Strain was caused by the lack of periodic rest and sleep.
- “exact power” myth & “wear always” myth:
My eye power is measured -4.5 (right) and -4.75 (left), but my eyes
feel comfortable only if both spectacle lenses are -4.5. Also, for
near-work (like computer use or reading the newspaper), my eyes are a
lot more comfortable with lenses of power -2 (ordinary glass lens spectacles without any coatings, purchased in 1998, and I’ve had absolutely no problem using a lower power). When eyes are strained, lenses of a power lower than the measured eye power have been a lot more comfortable. Sadly, many people are not being informed that severely strained eyes are a lot more sensitive. They remain stuck with the wrong belief that the lens power needs to be exact, and followup treatments revolve around lens power instead of realizing or checking that the primary cause of the strain may be the severe lack of sleep/rest/nutrition. I’ve also realized that it isn’t necessary to wear the spectacles
always. When reading a book or viewing my phone, or walking around my
house, I don’t need spectacles. However, when safety is important (like
driving, etc.), I use spectacles of -4.5.
- Dry eyes: It was extremely rare, and happened only when I lost sleep or when my eyes were over-strained. When I took rest, it always got resolved on its own within a few hours. Doctors found my tear film to be normal. Don’t forget to drink sufficient water and blink.
- Proper lens alignment: Even some expensive frames are designed wrongly. Even experienced opticians fit lenses at incorrect angles. It is astonishing how many of them don’t care, and tell people that nothing will happen, just to make a sale. Ensure that the lenses are properly aligned.
- Incorrect diagnosis: Doctors seem to assume astigmatism, or that the eye power is higher than what it actually is, when patients complain of eye strain (one doctor even jumped to the conclusion that I had dry eyes, even though I didn’t). Strained eyes can result in significant variations in eye power. It does not mean that one needs to immediately switch to new lenses. It’s important to reduce the strain first by getting proper sleep and rest. Doctors need to create/follow a standard practice of first ensuring the patient reduces the strain by getting proper sleep and rest for many days, and only then do a refraction test. During severe strain, even a refraction test done after pupil dilation can show the wrong power. There exists a phenomenon where the cramped/strained muscles cause the power to rise a little, and many nights worth of proper sleep relaxes those muscles and the power returns to what it was before the strain became severe. The power won’t reduce lower than that though. Doctors even prescribed cylindrical correction lenses which I couldn’t tolerate for even a few minutes (I detected the discomfort early because my eyes were already very severely strained. Like how simply touching a wound, hurts badly. I wonder how many people with lesser strain end up trying to tolerate such lenses because they don’t realize that it’s the wrong power). Even computerized eye tests and the pupil dilation test showed astigmatism and the wrong power. Oddly, every doctor gave me a slightly different eye power prescription, and each time, the cylindrical correction angle was different from the previous reading. I started spending most of my days either not wearing spectacles or using spectacles of a lower power (which didn’t cause any issue, by the way. It actually gave more relief), and when I started getting better sleep and rest, the strain reduced. This time, after getting a good night’s sleep, when I went to the doctor with well-rested eyes, my eye power was diagnosed correctly. Three doctors eventually concluded that I don’t have astigmatism. Over a period of time, my high level of strain helped detect and eliminate many misconceptions (which are still floating around). One doctor even recommended an MRI, but my family doctor told me not to, because there’s no point doing an MRI if you don’t know what you are looking for. One doctor prescribed antidepressants, saying the eye strain may be anxiety-related. My family doctor who couldn’t reach a conclusion, eventually said the stomach issues and eye issues may just be psychological. Doctors really need to receive more training to be better at diagnostics. To consider the entire case-history and lifestyle of a patient, and to be willing to look beyond the textbook.
- “Is this lens better or this one?”: As long as the spectacle lenses feel right, that’s the eye power to stop at (for driving etc. 20/20 vision from spectacles is obviously required. Commonsense). When my eye power was -4.25, and the doctor added another lens to make it -4.5 and asked whether the higher power was better, it appeared clearer and sharper to me (I didn’t realize it was too powerful), so I chose -4.5. I shouldn’t have done that. -4.25 was the correct power. When using the computer, I switch to -2.0 power ordinary glass lens spectacles without any coatings, and I’ve had absolutely no problem (spectacles purchased in 1998). When eyes are strained, lenses of a power lower than the measured eye power feel a lot more comfortable. Some people recommend wearing spectacles even if it feels uncomfortable or if it gives a headache, saying that the eyes would adjust after a few weeks. That’s very wrong advice. There are three scenarios I know of that causes this. 1. The lens power prescribed is wrong, or 2. The lenses are not aligned correctly, as shown in the image below, or 3. The eye muscles are too strained and sensitive to adjust to new spectacles. In the first two situations, I learned not to wear those spectacles. It caused more strain. In the third situation, it was necessary to wait until the strain reduced, before trying the new spectacles. A fourth possibility could be that a poor quality lens may be refracting light unevenly. Doctors need to look beyond the theory they studied, and get feedback from patients to understand the reality, and that the evaluation methodology of many researchers lacks knowledge about the ground realities (more info here).
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Sometimes, the spectacle lens ends up at a slightly incorrect angle. This image shows one axis. The angle variation can happen along other axes too. This caused my eyes to get strained faster. Don’t try to adjust to it. Ensure that an optician fixes the error or get a new frame/lens. Also, there are a lot of measurements that need to be done accurately when selecting the focal point, frame width and fitting the lens to the frame. |
- Low power prescriptions: I’m hearing of a lot of people being prescribed -0.25 or -0.5 prescriptions for one eye or both eyes. Even a cylindrical correction, just because they complain of eye strain. Please consider that these powers may just be a result of excess strain and/or lack of sleep. Wouldn’t wearing spectacles constantly prevent them from recovering to normal sight? We need to do better research and make life livable, to rescue people from poor habits that lead to weak vision, instead of providing people with spectacles at the slightest excuse.
- Bad habits from childhood: For goodness sake, please don’t mess up children’s sleep cycle. Not even for exams. Hard work is good, but losing sleep repeatedly to do hard work is foolish. Right from childhood, we have been taught to ignore discomfort and persevere, but we should have also been taught to recognize when we should stop and give our body the rest it needs.
- Work environments: Even in the most well-meaning work environments, bosses are pushed to deliver results quickly. But that doesn’t mean you need to damage your health in the process. Six hours of computer use a day is what I’d say is the safe-limit (eight hours may work for you, but never skip the rest breaks). When recovering from chronic eye strain though, not more than 4 hours is what I found is best. The entire world is realizing this necessary truth, and you shouldn’t be ashamed to take rest. Being a responsible person who gives their body the rest it needs is one thing. Laziness is an entirely different thing. Any sensible boss or colleague will know the difference.
- Online classes and smartphone/TV use: Teachers and parents need to ensure that students get some necessary breaks during online classes, smartphone use or while watching TV. Kids by nature won’t listen, but please ensure they get their rest, sleep and nutrition. Their disappointment at not being able to play video-games for long, is tiny compared to the disappointment of having to wear spectacles lifelong. The need to wear spectacles itself shows that the eyes are seriously affected. Don’t make it worse. Better still, don’t even allow it to reach a stage where anyone needs spectacles. Protect the eyes.
- Daytime sleep: If you couldn’t get proper sleep at night, you will feel sleepy during daytime. It is extremely important to take that nap. It gives some very essential rest for the eyes that’s even more effective than just keeping the eyes closed.
- Blue light and sleep: My experiments did not corroborate the studies that claim that blue light exposure late night causes sleep loss. What does affect sleep, is the amount of interest I have in something I do before sleep, which makes me force myself to stay awake. What I consume and how late in the night it is consumed also affects how late I fall asleep.
- Coffee/tea: When the body badly needs rest and you feel sleepy, you should sleep. Drinking coffee or tea to remain awake is a silly thing to do.
- The angle: If you extend your hand in front of you and hold a dumbbell for long, your muscles will start aching after a while. When it starts aching, if you raise your hand to hold the dumbbell above your head, some of your arm muscles will be spared of the weight of the dumbbell and get a chance to relax. The extraocular muscles holding the eyeball, are like the arms holding the dumbbell. Closing your eyes and lying down facing the ceiling helps those muscles relax a little bit (it gives just a slight bit of relief).
- Spectacles are not a cure: Some people assume that if they constantly wear spectacles or contact lenses for a few years, they will get cured to normal sight. It won’t. I've never tried "print pushing" though, but in the case of strained eyes, the first priority should be to allow the eyes to heal by getting proper sleep.
- Glass lenses are better: The medical and optical community is largely unaware of how distortions
in refraction affects strained eyes. During my chronic levels of strain,
plastic lenses always caused my eyes to get strained quicker than when I
used glass lenses. For some years, the discomfort was instant. Even Jack reports similar issues.
Not wearing spectacles gave the most relief. Now that I’ve recovered a
lot, I experience the strain a bit lesser, but long hours of strain add
up quickly, so I still prefer glass lens. Glass is well known for
offering better visual acuity and lesser distortion (provided it is of good quality). Of course there’s a
safety benefit to plastic lenses, but while sitting in front of a
computer, glass works best for me. Some opticians may bluff, saying that
glass lenses are not available. It is available and can be half the
price of plastic lenses. Do spectacles really need to cost as much as a
phone?
A certain company handbook I saw recently, mentioned that employees were only entitled to a ten minute break every two hours. A classic example of how rules are formulated from poor knowledge on Repetitive Stress Injuries. Please realize the seriousness of the matter and establish processes that help in creating a nation of healthy people. This also goes for everyone who knowingly or un-knowingly deprive people of sleep and rest right from childhood.
The human eye was not evolved to handle this kind of strain. Too many people are getting incorrect advice and hurting their eyes. Please tell more people about getting proper sleep and rest. There are not enough doctors emphasizing this.
Like someone once said:
“If you do not give time for wellness, you will be forced to make time for illness”.
CAUTION
Don't give up too soon. It can take several weeks/months to recover from acute strain, and it takes several months/years to recover from chronic strain. I initially took a 15 day vacation to check if it would cure the strain (during which I continued using the computer a lot). When it didn’t, I assumed that taking rest was of no use. I didn’t realize that I had severe sleep loss and was still overworking my eyes. The strain had built up to such a severe stage that longer periods of rest and sleep were required. The right thing to have done would have been to take a sabbatical for a year to ensure I got rest. Due to ignorance and bad advice, I continued working, and the problem persisted for several years. This applies even to conditions like back pain etc. When the body needs rest, give it rest. Any other work can wait. Else, you’ll end up with a severe burnout that will prevent you from working anyway.
p.s.: Do read through the article a few more times to understand all points, and when you get cured, please return to leave a comment. I recovered fully in October 2022. An ordeal that started in July 2011, and wrecked my career. It was prolonged due to the poor medical advice I received, the marketing nonsense that lies about being able to cure the strain, and due to the glaring lack of a support system in companies and in society.
Medical science is a science. Not a superstitious cult. That’s why doctors and researchers need to be open to new information and confirm it with experiments that are conducted using the right parameters and without bias. Helping people heal is important. History is witness to errors and corrections related to saturated fats, blood circulation, and more. Similarly, there is much that needs to be done to correct existing literature and help people avoid eye strain. I hope the medical community gives a priority to people’s health and to the spirit of scientific research.
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